depressants are the selective serotonin reuptake
inhibitors (SSRIs), which became available in the
1990s. Psychotherapy alone is sufficient treatment
for some people who have mild symptoms. There
are numerous types of psychotherapy, some of
which are able to make rapid progress in improv-
ing symptoms and others that extend over months
to years in an effort to fully expose, understand,
and address the issues underlying the depression.
Alternative and complementary therapies that
are often helpful includeACUPUNCTURE, MEDITATION
and other stress relief measures, and mind–body
approaches such as YOGAand TAI CHI. A number of
studies show that one to two hours of physical
exercise daily has the same effect as commonly
prescribed antidepressant medications on reducing
symptoms of mild to moderate depression. The
herbal remedy ST. JOHN’S WORT, available without a
doctor’s prescription as a dietary supplement in
the United States, also may relieve symptoms of
depression as effectively as prescription antide-
pressant medications. Many European countries
regulate St. John’s wort as a prescription product
and doctors prescribe it as a first-line treatment for
mild to moderate depression.
Do not take ST. JOHN’S WORTwhen tak-
ing a prescription antidepressant. Doing
so can result in a potentially life-threat-
ening complication called serotonin
syndrome.ELECTROCONVULSIVE THERAPY (ECT), which uses
electricity to momentarily disrupt the NERVEsignals
in the BRAIN, is an effective treatment for severe
depression that does not improve with medications
or for people who cannot take antidepressants.
Risk Factors and Preventive Measures
Family history is a significant factor for developing
depression or related conditions such as
CYCLOTHYMIC DISORDER, BIPOLAR DISORDER, andDYS-
THYMIC DISORDER. Depression may also develop in
reaction to persistent, intense stress or a traumatic
event such as the death of a loved one or diagno-
sis with a serious physical illness such as CARDIO-
VASCULAR DISEASE(CVD) or cancer.
Hormonal shifts in menstruating women
increase the risk for depression; women who have
substantial PREMENSTRUAL SYNDROME (PMS) symp-
toms also have a higher likelihood for developing
depression. As well, nearly all women experience
mild depressive symptoms in the first few weeks
after childbirth and up to 20 percent develop full
depression (POSTPARTUM DEPRESSION) that may last
as long as a year.
Researchers also have identified proteins associ-
ated with depression that either are missing or are
present in high levels. Early diagnosis and initia-
tion of treatment are the most effective measures
for heading off serious depression, though there
are no measures to actually prevent depression
from developing.
See also EXERCISE AND HEALTH RISK REDUCTION;
GENERALIZED ANXIETY DISORDER(GAD); HORMONE; MEN-
STRUAL CYCLE; POST-TRAUMATIC STRESS DISORDER
(PTSD); SUICIDAL IDEATION AND SUICIDE.dissociative disorder A psychiatric disorder in
which a person creates intentional though often
not conscious separation between self and a trau-
matic event. The most common form of dissocia-
tive disorder is dissociative amnesia, a form of
memory loss in which the person does not
remember the circumstances of a trauma, such as
childhood abuse or SEXUAL ASSAULT, and may not
remember that the events occurred at all. Amnesia
episodes are generally brief and contained to spe-
cific periods of time.
In dissociative fugue the amnesia is more
extensive and the person may adopt a new iden-
tity and life, believing he or she is the created
identity and dissociating entirely from the real
identity and life. Dissociative fugue typically fol-
lows a significant trauma, such as living through a
major natural disaster. The person may assume
the created identity for months and sometimes
years. Though dissociative fugue often appears as
an attempt to walk away from difficulties or
responsibilities, the person may not remember the
fugue upon returning to his or her real identity.
The most extreme form of dissociative disorder
is dissociative identity disorder (previously called
multiple personality disorder) in which one per-
son has two or more personalities. A person who
has dissociative identity disorder typically experi-
enced overwhelming trauma, such as abuse or the
loss of a parent or other family members, in child-372 Psychiatric Disorders and Psychologic Conditions